Vascular Complications of DM 2

Question 1

What are the microvascular complications of diabetes?

Answer 1

nephropathy, retinopathy, neuropathy

Question 2

What are the macrovascular complications of diabetes?

Answer 2

HTN, MI, TIAs/strokes, platelet hypersensitivity, PVD

Question 3

Describe the pathophysiology of diabetic nephropathy

Answer 3

Lesions occur in the glomeruli. Basment Membrane Thickens. the glomerulus becomes leaky due to the glomerular sclerosis. Kidneys and nephrons hypertrophy, hyperfiltration occurs increasing work on the kidneys. Can’t reabsorb excess glucose.

Question 4

What is microalbuminuria?

Answer 4

small but abnormal amounts of albumin in the urine (30-300mg/24hrs). leading indicator of developing nephropathy. strongest independent risk factor of cardiovascular disease

Question 5

Describe the progression of microalbuminuria to end stage renal disease

Answer 5

Progresses to macroalbuminuria (>300mg/hr). Steady drop in GFR leading to dialysis. Decline can be slowed by tight glucose control, BP control, protein restricted diet, smoking cessation

Question 6

What medications are used to treat diabetic nephropathy?

Answer 6

ACE inhibitors (Lisinopril)- need to check creatinine 7-10 days after initiating therapy, Angiotension II receptor blockers (ARB’s)- Cozar, antiproteinuric effect, cardioprotective.

Question 7

What characterizes nonproliferative diabetic retinopathy?

Answer 7

Increased capillary permeability and dilation of venules. Presence of microaneurysms, Hard exudates, Superficial retinal microinfarcts (cotton wool spots)

Question 8

What characterizes proliferative diabetic retinopathy?

Answer 8

neovascularization, sudden vision loss, neovascular glaucoma, blind/painful eye, retinal detachment, senile cataracts

Question 9

What are screening guidelines to prevent diabetic retinopathy?

Answer 9

Annual dilated fundoscopic exams by an opthalmologist. For women, dilated fundoscopic exam before conception and every 4-8 weeks of pregnancy

Question 10

How is diabetic retinopathy managed and treated?

Answer 10

tight glucose control, treatment of HTN, statins to decrease lipid deposition. Lasar photocoagulation or vitrectomy as surgical corrections of advance disease.

Question 11

What pathophysiologic changes are associated with diabetic neuropathy?

Answer 11

thickening of the walls of the nutrient vessels that supply the nerve (ischemia) and segmental demyelination of the Schwann cells

Question 12

What is the clinical presentation of somatic peripheral polyneuropathy?

Answer 12

glove and stocking distribution- pain, numbness, hyperthesias, paresthesias, sensory loss (proprioception and vibration)

Question 13

What are the diagnostic tests of neuropathy?

Answer 13

foot exam of each visit- color, sores, pressure areas, feel for pulses, capillary refill. neuro exam to include monofiliment test, reflexes, vibratory sensation, proprioception

Question 14

What medications can be used to treat diabetic neuropathy?

Answer 14

Elavil (Amitryptilene), ASA, Tylenol, NSAIDS, Tegretol (Carbamazapine), Neurontin, (Gabapentin)- works thru GABA, Lyrica (Pregabalin), Cymbalta (Duloxitine)

Question 15

What is the clinical presentation of autonomic neuropathy?

Answer 15

Gastric dysmotility - Gastroparesis, orthostatic HTN, cardiac disrhythmias, bladder incontinence, ED

Question 16

What medications are used to treat orthostatic HTN?

Answer 16

Florinef (Fludrocortisones) and Midodrine (ProAmatine)

Question 17

What medications are used to treat gastraparesis?

Answer 17

Erythromycin, Imodium (Loperamide), Metocloperamide (Carbamazepine)

Question 18

What is diabetic amyotrophy?

Answer 18

Muscle atrophy and weakness of the anterior thigh or pelvic girdle

Question 19

Define atherosclerosis

Answer 19

Chronic inflammatory disorder of intima of large blood vessels characterised by formation of fibrofatty plaques called atheroma

Question 20

Why should beta blockers be used cautiously in diabetics?

Answer 20

may mask warning signs of hypoglycemia (adrenergic blunting)

Question 21

How can macrovascular complications be delayed in diabetics?

Answer 21

optimal BP, HDL> 40 (men), >50 (women). Triglycerides <150. 30 minutes of moderate-intensity activity everyday. BMI of 18.5-24.9. Antiplatlet agents

Question 22

What are the primary sites of PVD?

Answer 22

Femoral & Popliteal arteries: 80-90%. Tibial & Peroneal arteries: 40-50%. Aorta & Iliac arteries: 30%

Question 23

What is the ankle-brachial index (ABI)?

Answer 23

SBP in ankle (dorsalis pedis and posterior tibial arteries) divided by SBP in upper arm (brachial artery)

Question 24

How are ankle-brachial index values clinically classified?

Answer 24

Normal > 0.90, Claudication: 0.50-0.90. Rest pain: 0.21-0.49, Tissue loss < 0.20

Question 25

What does the ADA recommend for screening of PAD?

Answer 25

Those >50 years of age: If normal ABI an exercise test should be carried out. The ABI test should be repeated every 5 years.